title: Hierarchical screening for multiple mental disorders.
abstract: BACKGROUND
  There is a need for brief, accurate screening when assessing multiple mental disorders. Two-stage hierarchical screening, consisting of brief pre-screening followed by a battery of disorder-specific scales for those who meet diagnostic criteria, may increase the efficiency of screening without sacrificing precision. This study tested whether more efficient screening could be gained using two-stage hierarchical screening than by administering multiple separate tests.
  
  
  METHODS
  Two Australian adult samples (N=1990) with high rates of psychopathology were recruited using Facebook advertising to examine four methods of hierarchical screening for four mental disorders: major depressive disorder, generalised anxiety disorder, panic disorder and social phobia.
  
  
  RESULTS
  Using K6 scores to determine whether full screening was required did not increase screening efficiency. However, pre-screening based on two decision tree approaches or item gating led to considerable reductions in the mean number of items presented per disorder screened, with estimated item reductions of up to 54%. The sensitivity of these hierarchical methods approached 100% relative to the full screening battery.
  
  
  CONCLUSIONS
  Further testing of the hierarchical screening approach based on clinical criteria and in other samples is warranted.
  
  
  CONCLUSIONS
  The results demonstrate that a two-phase hierarchical approach to screening multiple mental disorders leads to considerable increases efficiency gains without reducing accuracy. Screening programs should take advantage of prescreeners based on gating items or decision trees to reduce the burden on respondents.
authors.affiliation: Centre for Mental Health Research, The Australian National University, Canberra, Australian Capital Territory, Australia. philip.batterham@anu.edu.au
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Batterham
authors.forename: Alison L
authors.initials: AL
authors.lastname: Calear
authors.forename: Matthew
authors.initials: M
authors.lastname: Sunderland
authors.forename: Natacha
authors.initials: N
authors.lastname: Carragher
authors.forename: Helen
authors.initials: H
authors.lastname: Christensen
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Mackinnon
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology; D008875:Middle Aged; D016584:Panic Disorder / Q000175:diagnosis / Q000523:psychology; D010698:Phobic Disorders / Q000175:diagnosis / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D011570:Psychiatry / Q000379:methods; D011599:Psychopathology; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Anxiety disorders; Depression; Screening